Health Insurance PPOs, HMOs, CDHPs Explained... Learn Price-Transparency and Other Tricks

Health Insurance Plan Designs are VERY Confusing. This Video Explains Them All:

PPO Plans - Learn How Family Deductibles and In-Network and Out-of-Network Benefits REALLY Work.

POS Plans - Learn How Out-of-Network Doctor and Hospital Services Are Usually NOT Covered.

HMO Plans - Learn How Primary Care Physician (PCP) Gatekeepers Control IF You Can See a Specialist and HOW They Tell You Exactly Who You Can and CANNOT See.

CDHP Plans - Health Savings Accounts, Health Reimbursements Replace Copays... Learn the Implications.

Price-Transparency - In-Network Prices for the Same Service with the Same Insurance Differ by 500% or More Depending on the Doctor and Hospital. Don't Get Caught with a HUGE Bill.

Reference-Based Pricing - Some Health Insurance Plans Opt-Out of the In-Network Game... But There are Some Hidden Consequences.

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[JB-qtwo]

Dr. Bricker…I have been alive on this planet for 31 years, and you are the first human being who has actually described the different healthcare plans in a way that makes sense. Thanks.

[debmclranroache]

I am a family nurse practitioner who thoroughly enjoy your presentations. You’ve made it so easy to understand this complicated world of insurance. I have learned so much from your classes even better than anything that I have learned in school. Please keep up the good work. Thank you.

[TZach]

The first rule of healthcare in this country: Don't get sick

[SalmanKhan-rmkk]

i have been alive on tis planet for 31 years, and you are the first human being who have actully described the

[mrsbootsworkouts]

Great explanation of components of health insurance process - co-pay, deductibles, accounts, out of pocket max, and different insurance plans!

[pedrotinaco]

Thanks for the information. That helps me, as a postal (or any federal ) employee make an informed decision on whether we need to change our health plan during our open season

[wednesdayschild]

I have a health sharing ministry. I pay and get reimbursed. I shop around. I also read the reports to see if I really need that test. Check choose wisely. Try to do direct primary care. I am in control of my healthcare not the plans or insurances.

[Guyatwo-m]

I don't want to understand but I'm grown now have to accept these Terms and Agreements because I'm an adult now

[NANA-ndkq]

"Health Insurance" is the monetization of the (unenforceable) promise of future performance of non-disclosed 'allowed' goods and services by non-obligated contractors (licensed medical providers) at unknown prices.
To be clear: the monetization flows only to the seller of this financial contract aka 'Insurance', and benefits neither Buyer or Seller in the actual healthcare transaction.

[georgenelson]

Sound advice! I will follow you from now on. Keep up the AWESOME WORK!

[wkcsgii]

Does any other country make this as difficult as the US?

[rvrpropertiesllc]

Excellent presentation. You made a complex topic very simple.

[aaronhamburger]

Have you thought about doing a series on essentials for healthcare investors?

[dxrulez]

Hi Dr. Bricker, I haven’t finished watching the video yet, but I was wondering about cost sharing. For in network in particular, are plans with copays, co insurance, and deductibles driven by insurance (I.e. insurance wants to save money through cost sharing) or through consumer preference (I.e. consumers tend to purchase the lowest premium plan)? Thank you.

[replymedia]

Great video, thank you for putting this information out in a way that is understandable

[lauracohen]

Thank you for this comphrensive explanation.

[showmeTDs]

Hi Dr. Bricker! Thank you for creating this simplified explanation of medical care coverage! I have a question for you. I will be working for a small business for the first time, and they offer POS insurance. For primary care visits, the insurance plan says "Deductible, then 0% coinsurance". What does this mean? I thought POS plans covered primary care visits just like PPO plans. Also, does a POS plan require a referral for all specialist care? For example, if I need to go to the gynecologist, would that require a referral?

[tamzidhossain]

Hi Dr. Bricker,

Would love to know what your thoughts are about digital pharmacy companies like Capsule, Truepill etc and how they make money. How are they different than PBM owned Pharmacies?

[jeffs]

Pricing "transparency" sounds good but is not what it seems. I just tried obtaining the info from three of my local hospitals. First off, finding the link on their websites is not straightforward. Once found, each hospital's downloaded file was in a different format, one a csv, one a json and one xml. The csv was no problem. Just open in Excel. The other two forget about it. I'm fairly tech savvy but could not open either of them to be usable. The file I was able to open revealed how wildly the prices vary based on what insurance plan you happen to be on. It's ridiculous.

[dothvarter]

What's even the point if they don't deduct anything then turn around and raise your rates. Is there any kind of program or legal binding that refuses out of network involvement?